HIV and AIDS in closed settings: Issues and Challenges (Dr. Fabienne Hariga, MPH)

8/7/2019 HIV and AIDS in closed settings: Issues and Challenges (Dr. Fabienne Hariga, MPH)

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HIV AIDS SECTION

HIV and AIDS in closed settings

Issues and Challenges

Journalist Global Media TrainingNational Press Foundations Journalist

Vienna, 14 July 2010

Dr Fabienne Hariga

Global focal point for HIV in prisons


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30 million people incarcerated each year in prisonsonly;

HIV prevalence in prison can be very up- to 65%;

50-80% of deaths in prisons reported to be due to TB(WHO)

Proportion ofIDUs, can be very high (80%)

Number of drug users detained in C

DTC?


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HIV prevalence in prison higher than in the

community

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Mexico

RussianF

ederation

Latvia

Switzerland

France

Indonesia

Spain

Brazil

Vietnam

M

orocco

Cted'Ivoire

SouthAfrica

HIV Prevalence rates in general population and in prisons in selected countries

General adult population

Up-to in prison population


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HIV prevalence in

women prison

almost alwayshigher than in men

prisons.

0%

5%

10%

15%

20%

25%

30%

BRAZ

IL

USA(CT

)

MOLD

OVA

INDIA

PAKISTAN

GABO

N

RWAN

DASPAIN

HIV prevalence rates in women / men prisons in selected countries

HIV P rev Women in prison

HIV prev Men in Prison


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HIV and HIV/TB in prison: contributing factors

1. Criminal Justice /Legal framework: over-representation ofmostvulnerable population groups forHIV

2. All modes of transmission occurring in the community, occur in prison:

sexual transmission (consensual, forced)

blood transmission (injecting drugs, tattooing, and nosocomialinfections (through health care), fights)

vertical transmission: mother to child transmission

3. Poor prison conditions: overcrowding, malnutrition, poor ventilation,hygiene

4. Poorprison management: violence, gangs, corruption

5. Low access to health care (preventive, curative, reproductive andpalliative) and weak or nonexistent linkages with public health sectorand NGOs

6. Stigma and discrimination for PLWH, for detainees; for drug users ,MSM

7. Denial & lack of interest


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Key elements to be addressed

Introducing comprehensive HIV prevention,

treatment & care

Providing equivalent health care services to thosein the community

Improving prison conditions and undertaking prison

reforms

Reducing prison population and undertaking

criminal justice reforms


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A multi factorial issue requiring a multidisciplinary response

Public Health

Occupational health

Criminal Justice

Gender policies

Human Rights

Prison management


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Comprehensive HIV response (staff and

prisoners) Access to information (IEC), peers prevention

Access to Voluntary Counselling & Testing (VCT)

Prevention, treatment of STIs and condoms programming

Access to safe injection equipment, tattooing eq., Access to evidence-based drug dependence treatments

including opioid substitution

Access to ARV (Treatment, PEP, PMTC)

Access to protective equipment (staff)

Prevention ofsexual violence, conjugal visiting rooms

Universal precaution

Prevention and treatment ofTB and HIV/TB collaborative


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Dont do

Mandatory HIV testing

Segregation of PLWH

Send people to prisons for so called treatment


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Challenges

Overuse of imprisonment and underuse of alternatives Legal contexts

Prison authorities are often isolated from other nationalhealth authorities such as M.o.H, drug control agencies,national AIDS councils, or CCM;

Denial that HIV in prison is a problem, that transmissionoccur in prison

Many authorities are concerned but lack of politic and publicinterest

Health, tuberculosis and HIV in prison poorly funded

Poorly represented in national AIDS strategies

Poorly (not) included in GF proposals


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Some important Prison indicators

Prison population rate: Number of prisoners / 100 000 hab.

% pre-sentenced prisoners

Occupancy rate

Classification system: Women

Children

Pre-trial

Proportion of drug users (MSM, Sexworkers)

Prevalence HIV/TB/HCV/HBV Mortality rates

HIV services available/coverage


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Remember !

HIV in prisons: all regions are concerned

UNODC programmes should address HIV/TB in

prisons for all (and not only HIV and Drug users inprisons)

There are many issues, many challenges but also

opportunities!


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THANK YOU

WWW.UNODC.ORG/AIDS

Documents

HIV and AIDS in closed settings: Issues and Challenges (Dr. Fabienne Hariga, MPH)